左甲状腺素钠片对妊娠中期亚临床甲状腺功能减退症患者维生素D及骨代谢指标的影响

Effects of Levothyroxine Sodium Tablets on Vitamin D and Bone Metabolism Indexes in Pregnant Women with Subclinical Hypothyroidism at the Second Trimester

目的:探讨左甲状腺素钠片对妊娠中期亚临床甲状腺功能减退症患者维生素D及骨代谢指标的影响。方法:回顾性选取2017年1月至2018年12月保定市第一中心医院收治的妊娠中期亚临床甲状腺功能减退症患者90例,根据是否应用左甲状腺素钠片分为治疗组和对照组,每组45例。治疗组患者采用左甲状腺素钠片治疗,且每隔4周行甲状腺功能复查;对照组患者未接受左甲状腺素钠片治疗,定期行甲状腺功能复查。比较两组患者治疗前后甲状腺功能,25-羟基维生素D[25-(OH)-D]、甲状旁腺素(PTH)、骨钙素(BGP)、Ⅰ型前胶原N端前肽(PⅠNP)及骨密度水平的差异,观察两组患者的妊娠结局。结果:治疗8周后,治疗组患者促甲状腺激素水平较治疗前明显降低,25-(OH)-D、BGP、PⅠNP及骨密度较治疗前明显升高,差异均有统计学意义(P<0. 05);对照组患者上述指标水平较治疗前无明显变化,差异均无统计学意义(P>0. 05);治疗组患者上述指标水平明显优于对照组,差异均有统计学意义(P<0. 05)。治疗组患者的不良妊娠结局发生率为11. 11%(5/45),明显低于对照组的28. 89%(13/45),差异有统计学意义(P<0. 05)。结论:左甲状腺素钠片能够有效降低妊娠中期亚临床甲状腺功能减退症患者促甲状腺激素水平,调节骨代谢、25-(OH)-D水平,从而改善妊娠结局。

OBJECTIVE: To observe the effects of levothyroxine sodium tablets on vitamin D and bone metabolism indexes in pregnant women with subclinical hypothyroidism at the second trimester. METHODS: Totally 90 pregnant women with subclinical hypothyroidism at the second trimester admitted into the First Central Hospital of Baoding from Jan. 2017 to Dec. 2018 were extracted to be divided into the treatment group and the control group according to whether or not levothyroxine sodium tablets were used,with 45 cases in each group. The treatment group was treated with Levothyroxine sodium tablets,and patients’ thyroid function was reexamined every 4 weeks. The control group only received regular reexamination of thyroid function. Changes in thyroid function,25-hydroxyvitamin D [25-( OH)-D],parathyroid hormone( PTH),bone gla protein( BGP),procollagen type Ⅰ N-terminal propetide( PⅠNP) and bone mineral density before and after treatment were compared between two groups,and pregnancy outcomes were observed.RESULTS: After treatment of 8 weeks,the levels of thyroid stimulating hormone in the treatment group were significantly lower than those before treatment,and 25-( OH)-D,BGP,P ⅠNP and bone density were significantly higher than those before treatment,and the differences were statistically significant( P<0. 05). The above indicators in the control group showed no significant changes compared with those before treatment,and the differences were not statistically significant( P>0. 05),the above indicators in the treatment group were significantly better than those in the control group,with statistically significant differences( P<0. 05). The incidence of adverse pregnancy outcomes in the treatment group was 11. 11%( 5/45),significantly lower than that in the control group [28. 89%( 13/45) ],with statistically significant difference( P < 0. 05). CONCLUSIONS: Levothyroxine sodium tablets can effectively reduce TSH levels in patients with subclinical hypothyroidism at the second trimester, regulate bone metabolism and 25-( OH)-D levels,so as to pregnancy outcomes.